[gary.keith]

I tested my BG this morning upon awakening and it was, as usual, slightly high at 147. So I bolused 3 units of Novolog.

Yes, I know I said I'd wait before doing this on my own, but it's my body and my life and if the endo doesn't like it that's her problem!

An hour later I tested again and my BG was up to 169. At that point I was ready for breakfast so I bolused my prescribed 25 units of Novolog and proceeded to make breakfast. Half a cup of hot rolled oats with a tablespoon of Agave nectar. Two scrambled egg beaters. In all a 67 carb breakfast. Note to self: we really need a lower carb breakfast.

An hour later I checked my BG again and it was 245! That's never happened before.

And so here I sit wondering what I should do. I'm thinking about an 11 unit bolus of Novolog, which is what my logging software is recommending.

I know you folks can't tell me what to do. So how about I ask what would you do in a situation like this?

[Subby]

In the absence of experience, and if I was type 2 with some internal insulin function that meant that things (eventually) come down or stabilise to some degree, I would not take a correction, or take only a small correction. Personally 11 units would feel like too much of a risk, within the context of the doses you have been talking. It might be unpleasant to be high, but you don't want to bring on a potentially brutal low.

245 might feel and be high for you, but it is hardly danger zone as far as a real short term danger, if you take it easy, monitor, drink plenty of fluids. If I was still high or getting higher in a few hours, I might consider some medical help.

And while speaking strictly for self, I'd be aiming for about a 20 - 30g carb breakfast, only carbs I know do not badly spike me (I would know through observation, trial and error) and would expect a definite improvement in post meal blood sugar

[fgummett]

Your profile shows you as a Type 2 so assuming you do still have some of your own insulin I'd suggest holding off on any additional insulin and to keep testing to see what direction your BG is heading.

There is a possibility that you actually went low and this is a rebound high... adding more insulin on top of what you already have "on board" could just send you on another roller-coaster ride.

Another possibility is that the insulin was ineffective... in which case your BG may have just been going higher since you woke up... in all probability it will start to come down.

By testing (every 15 - 30 minutes is not a bad idea) you can gain a better idea of where you are and what to do next. Are you stable, going up or going down?

---

ETA my post crossed with Subby's but I think we are both conveying the same message.

[gary.keith]

Thanks for the quick replies and good advice. The 245 was at 11:11 AM Eastern Time. I just tested again at 11:39 AM and it's 219. I'll keep testing.

[fgummett]

That's going in the right direction

I'm wondering if your logging software (iPhone app?) makes allowance for Insulin On Board? Most Insulin Pumps will suggest a lower correction bolus within about 2 hours of a previous bolus; as at least some of the previous insulin is still active in your system. By simply giving the preset amount per carbs, or per BG correction, regardless of time since last bolus, you can end up with a cumulative effect of too much insulin.

[jenb]

If you started breakfast at 169, the rise to 245 is really not that unexpected. In the future you might want to postpone eating and do a little cardio to bring your BG down to a lower starting point. Also try bolusing at least 20 minutes before you begin eating so that your insulin has a chance to kick in at about the same time the glucose from your meal is entering your system.

Jen

[fgummett]

That is true Jen but for some if the morning raise is DP, it can tend to keep raising until we eat... D seems to get us coming and going As ever the answer seems to be testing for yourself and establishing repeatable patterns that work for you.

[gary.keith]

Originally Posted by fgummett

That's going in the right direction

I'm wondering if your logging software (iPhone app?) makes allowance for Insulin On Board? Most Insulin Pumps will suggest a lower correction bolus within about 2 hours of a previous bolus; as at least some of the previous insulin is still active in your system. By simply giving the preset amount per carbs, or per BG correction, regardless of time since last bolus, you can end up with a cumulative effect of too much insulin.

I'll ask the developer about that. It makes a lot of sense so my guess is it does. But I learned long ago never to make assumptions about other people's logic.jenb;518225]If you started breakfast at 169, the rise to 245 is really not that unexpected. In the future you might want to postpone eating and do a little cardio to bring your BG down to a lower starting point. Also try bolusing at least 20 minutes before you begin eating so that your insulin has a chance to kick in at about the same time the glucose from your meal is entering your system.

Jen[/quote]

For me the rise was quite dramatic. I tend to eat the same breakfast each day, at least in terms of carbs, and have never seen this high a spike before.

BG is continuing to go down. Latest number is 197.

[It Ain't Over]

Anytime you find and unexpected occurance of insulin resistance always be on the watch for an infection, cold, or flu starting up. This is the time of year and any of the above will cause insulin resistance.

[gary.keith]

Originally Posted by It Ain't Over

Anytime you find and unexpected occurance of insulin resistance always be on the watch for an infection, cold, or flu starting up. This is the time of year and any of the above will cause insulin resistance.

I do have a bladder infection. I've been taking 500 mg of Cipro twice a day since last Friday. The sensations I'm experiencing haven't gotten any better so my PCP said I should see my urologist. I'm going tomorrow at noon. Still, I've never had any abnormal spikes like this after breakfast unless I eat something that I know makes me spikey like real syrup instead of Agave nectar.

195 @ 12:32 PM. Seems like it's stabilized for now, albeit still higher than I'd like it to be. But now it's almost lunchtime and another 25 units of Novolog so I'll wait instead of bolusing now.

[Subby]

In order for any software to be ballpark on the correction, it needs ISF (insulin sensitivity or correction factor or how much one unit brings you down X mg/dl) and an awareness of all recent bolusing, such as the breakfast (IOB, and an algorythm for the particular insulin to predict the remaining effect at a given moment in time. Hopefully finetuned to your body, based on a different set of observations).

Usually one would not correct 2 hours after a meal, as even if the BG is high, that may be a variation in the way the insulin and food is still nuking it out, insulin action will still be in progress, and food action may or may not be about to run out. I don't think my pump (which of course takes ISF, IOB into account) would suggest much at all within 2 hours if I put 250 mg/dl or so into it, given a high carb meal (meaning a lot of insulin used). It conservatively and safely recognises that the remaining insulin may in fact be enough to return me to normal or close to normal in the future.

By "safely" I don't mean it's right: I mean that as far as a prediction from a machine with limited information, it's the safest suggestion. The previous bolus might bring me down a little later: a full correction without insulin on board considered could effectively double or triple the required insulin in me and land me in very hot water.

The exception is when you really know what is going on, what went wrong, and you can really predict strongly what a dose is likely to be doing. As in, after a lot of observation of the particular foods and corrections, and knowing why a meal might have stuffed up.

I actually also wonder if another possibility is you had slow absorption on the shot, letting the carbs get a jump start. Unfortunately injections can just vary sometimes, depending what exact type of of flesh you hit.

[howdysf]

25 units of novolog seems like an awful lot!

[gary.keith]

Originally Posted by howdysf

25 units of novolog seems like an awful lot!

As I understand it, my body is still fighting the urge to have normal BG, so it still takes a lot of insulin to get the desired results. I'm just under four weeks into this journey when I was DXed with a BG of 1,240.

I had an almost no-carb lunch. Salad with red onions, grape tomatoes, broccoli florets, this really good (Walden Farms) no fat, no carb, no sugar, no cholesterol dressing I found in the produce section of the supermarket, and a quarter chicken chunked and tossed in.

Before lunch I bolused 5 units Novolog instead of the prescribed 25 units. One hour PP BG is 122. I'm happy again!

I'm glad I took everyone's advice here and waited on the bolus when BG was 245.

[jenb]

Originally Posted by fgummett

That is true Jen but for some if the morning raise is DP, it can tend to keep raising until we eat... D seems to get us coming and going As ever the answer seems to be testing for yourself and establishing repeatable patterns that work for you.

Oooh, that DP is really a nasty beast. I'm subject to it too, and try to hit it at 6:15 a.m. with a little half unit bolus before it can get going. The food intake thing is more a T2 difficulty?

The more I know about diabetes, the more I know I don't know!!!

Jen

[gary.keith]

Two hour PP was 80.

Lunch was just six grams of carbs so perhaps 5 units of Novolog was a bit.

I'm still testing every 30 minutes.

Jen, yep so far DP has been my only ongoing battle that I can't seem to win. Right now I'm stuck between two options that I can see. First is keeping something slightly carby on my nightstand and have that as soon as I wake up. Second is bolusing a small amount to cover it until breakfast.